Association Between Environmental Particulate Matter and Carpal Tunnel Syndrome in Patients Undergoing Hemodialysis

Abstract

Background/Aims: The deposition of β2-microglobulin induced by reactive inflammation causing carpal tunnel syndrome (CTS) is one of the complications of dialysis-related amyloidosis in maintenance hemodialysis (MHD) patients. Air pollution levels, especially particulate matter with an aerodynamic diameter of <2.5 mm (PM_2.5)_, have significantly been associated with the elevation of systemic inflammatory markers. There is no previous research on possible associations between CTS and PM_2.5. Methods: This study enrolled 866 MHD patients treated at the outpatient HD centers. Senior neurologists diagnosed the presence of CTS. Air pollution levels were recorded by a network of 27 monitoring stations near or in the patients’ living areas throughout Taiwan. The 12- and 24-month average concentrations of PM with an aerodynamic diameter of <10 and <2.5 mm (PM₁₀ and PM_2.5, respectively), sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone were included. Results: Multivariate logistic regression analyses showed that HD duration, the normalized protein catabolic rate (nPCR), hypoalbuminemia (albumin < 4 g/dl), and the mean previous 12-month environmental PM_2.5 were positively associated with CTS; HD duration, nPCR, hypoalbuminemia (albumin < 4 g/dl), and the mean previous 24-month environmental PM_2.5 were positively associated with CTS; HD duration, hypoalbuminemia (albumin < 4 g/dl), and previous 12-month PM_2.5 excess days were positively associated with CTS; and HD duration, nPCR, hypoalbuminemia (albumin < 4 g/dl), and previous 24-month PM_2.5 excess days were positively associated with CTS. Conclusion: PM_2.5 levels and PM_2.5 excessing days were positively correlated with CTS.

Hepatitis C virus and carpal tunnel syndrome in hemodialysis patients: a single center cross-sectional study

“…Incidence of CTS was statistically significantly higher in patients with anti-HCV-positive or HCV infection by univariate analysis [3,4,15,21,32]. However, after adjustment for dialysis vintage by multivariate logistic regression, this association disappeared [3,15,32], which is inconsistent with our findings. In our multivariate logistic regression analysis, unexpectedly, HCV-RNA replication was related to CTS, whereas anti-HCV-positive was not.…”

“…CTS was diagnosed according to (1) signs or symptoms verified by nerve conduction examination; (2) clinical CTS diagnosis of nocturnal pain, numbness in the median nerve distribution, and a positive Tinel sign/ Phalen sign; (3) prolonged sensory and/or motor latencies from the wrist to the digits innervated by the median nerve in the electrophysiological test; or (4) the median nerve cross-sectional area exceeding 10 mm 3 or compression rate over 20% by ultrasonography [17,18]. Meeting each one of the four criteria supported the diagnosis of CTS.…”

“…Recently, numerous studies have shown that HCV infection causes greater oxidative stress than any other inflammatory liver disease [9][10][11][12][13][14]. However, few studies have focused on the relationship between HCV infection and CTS in MHD patients [3,4,15]. HCV infection is a common problem associated with increased risk of cardiovascular events [16] and lower quality of life in MHD patients.…”

Carpal tunnel syndrome and exposure to work-related biomechanical stressors and chemicals: Findings from the Constances cohort

“…Little epidemiological data is available on the impact of chemical exposure on the risk of CTS despite their potential neurotoxicity [20][21][22][26][27][28][29]31,36,37,49]. Chemical exposure was taken into account in a case-control study of CTS conducted in the general population of Wisconsin, but no significant association was found with CTS after adjustment for the main personal, medical and biomechanical risks [50].…”

“…The oldest one was by Bleecker in 1986, the author proposed to examine the vibration perception of workers co-exposed to neurotoxic agents and to biomechanical overload of hand and forearm, with the aim to consider the possible co-presence of damages due to chemical substances and to nerve compression [26]. Among the others papers, two were regarding co-exposure to pesticides [27,28], one was concerning the low-level chronic exposure to lead [29], one was on Toxic Oil Syndrome [30], and the last-one regarded particulate matter [31].…”